Health Policy and Management (보건행정학회지)

Korean Academy of Health Policy and Management (한국보건행정학회)
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The Effect of Gender on Catastrophic Health Expenditure in South Korea: Gender-Based Approach by Subgroup Analysis

개인의 성별이 재난적 의료비 지출 여부에 미치는 영향: 세부집단분석을 통한 젠더적 접근

  • Kim, Yeonsoo (Department of Public Administration, Ewha Womans University) ;
  • Kim, Hyeyun (Department of Chronic Disease Control Research, Korea Centers for Disease Control and Prevention)
  • 김연수 (이화여자대학교 행정학과) ;
  • 김혜윤 (질병관리본부 만성질환관리과)
  • Received : 2018.07.31
  • Accepted : 2018.08.21
  • Published : 2018.12.31
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Abstract

Background: Catastrophic health expenditure (CHE) occurs when medical expenditure of a household passes over a certain ratio of household income. This research studied the effect of gender on CHE based on Korea Health Panel data. Methods: This study implemented binary logistic regression model to figure out whether gender affects CHE and how different gender groups show pattern of CHE process. With gender, age, marital status, income level, economic activity, membership of private insurance, existence of chronic disease, and self-rated health were included in the model. Results: Results showed that females faced CHE 1.5 times more than males (odds ratio, 1.241). Also, main determinants of CHE in female groups were marital status, while age and economic activity status were significant in male groups. Subgroup analysis displayed that married female under 35 years old are located in intersectionality of CHE including pregnancy and delivery, multiple health risk behaviors, mental stress, and relatively vulnerable social status due to lower income. Meanwhile, both gender above 50 years old faced remarkably high chance of CHE, which seems to be caused by complex health risk behaviors and chronic diseases. Conclusion: Such results implied not only that gender is an important determinant of CHE, but also other determinants of CHE differ according to gender, which suggests a necessity of gender-based CHE support and rescue policy.

Keywords

Table 1. Composition of annual individual health expenditure

BGHJBH_2018_v28n4_369_t0001.png 이미지

Table 2. Operational defnition of variables

BGHJBH_2018_v28n4_369_t0002.png 이미지

Table 3. General characteristics of the study sample

BGHJBH_2018_v28n4_369_t0003.png 이미지

Table 4. Gender pattern of individual and CHE

BGHJBH_2018_v28n4_369_t0004.png 이미지

Table 5. Pattern of catastrophic health expenditure among subgroups

BGHJBH_2018_v28n4_369_t0005.png 이미지

Table 6. Gender analysis of spending catastrophic health expenditure

BGHJBH_2018_v28n4_369_t0006.png 이미지

References

  1. Lee HJ, Lee TJ. Factors associated with incidence and recurrence of household catastrophic health expenditure in South Korea. Korean Soc Secur Stud 2012;28(3):39-62.
  2. Kim Y, Yang B. The trend in catastrophic health payments by income strata in South Korea. Korean J Health Econ Policy 2009;15(1):59-77.
  3. Huh SI, Choi SJ, Kim CY. Income elasticity of household health expenditures and differences by income level. Health Policy Manag 2007;17(3): 50-67. DOI: https://doi.org/10.4332/kjhpa.2007.17.3.050.
  4. Kim E, Kwon S. The effect of occurrence and reoccurrence of catastrophic health expenditure on transition to poverty and persistence of poverty in South Korea. Health Policy Manag 2016;26(3):172-184. DOI: https://doi.org/10.4332/KJHPA.2016.26.3.172.
  5. Song EC, Shin YJ. The comprehensive health expenditure ceiling system to prevent catastrophic health expenditure: focusing on applicability using cost estimation. Health Soc Welf Rev 2015;35(2):429-456. DOI: https://doi.org/10.15709/hswr.2015.35.2.429.
  6. Kim Y, Yang B. Relationship between catastrophic health expenditures and household incomes and expenditure patterns in South Korea. Health Policy 2011;100(2-3):239-246. DOI: https://doi.org/10.1016/j.healthpol.2010.08.008.
  7. Limwattananon S, Tangcharoensathien V, Prakongsai P. Catastrophic and poverty impacts of health payments: results from national household surveys in Thailand. Bull World Health Organ 2007;85(8):600-606. DOI: https://doi.org/10.2471/blt.06.033720.
  8. Xu K, Evans DB, Kawabata K, Zeramdini R, Klavus J, Murray CJ. Household catastrophic health expenditure: a multicountry analysis. Lancet 2003;362(9378):111-117. DOI: https://10.1016/S0140-6736(03)13861-5.
  9. Woo KS, Shin YJ. The effect of catastrophic health expenditure on household economy: focusing on financial coping and poverty. Health Soc Welf Rev 2015;35(3):166-198. DOI: https://doi.org/10.15709/hswr.2015.35.3.166.
  10. Sen G, Iyer A. Who gains, who loses and how: leveraging gender and class intersections to secure health entitlements. Soc Sci Med 2012;74(11):1802-1811. DOI: https://doi.org/10.1016/j.socscimed.2011.05.035.
  11. Sen G, Iyer A, George A. Systematic hierarchies and systemic failures: gender and health inequities in Koppal District. Econ Polit Wkly 2007;42(8):682-690.
  12. Song DY. Women, health, and wellbeing. Issues Fem 2001;(1):149-180.
  13. Lee GJ. A study on a relationship between care burden and health service utilization of middle-aged women. Womens Health 2014;15(1):1-15.
  14. Jeon GS, Choi ES, Lee HY. Gender-related difference in the utilization of health care services by Korean adults. J Korean Public Health Nurs 2010;24(2):182-196. DOI: https://doi.org/10.5932/JKPHN.2010.24.2.182.
  15. Mead H, Witkowski K, Gault B, Hartmann H. The influence of income, education, and work status on women's well being. Womens Health Issues 2001;11(3):160-172. DOI: https://doi.org/10.1016/s1049-3867(01)00083-4.
  16. Sohn SI, Shin YJ, Kim CY. Factors influencing household catastrophic health expenditure of the poor. Health Soc Welf Rev 2010;30(1):92-110. DOI: https://doi.org/10.15709/hswr.2010.30.1.92.
  17. Hun SI. Changes in the financial burden of health expenditures by income level. Health Welf Policy Forum 2009;(149):48-62.
  18. Saksena P, Xu K, Durairaj V. The drivers of catastrophic expenditure: outpatient services, hospitalization or medicines. Geneva: World Health Organization; 2010.
  19. Moon JY, Choi YJ, Seo NK. A comparative study on factors related to the health expenditure of different household types of the elderly with chronic disease. Health Soc Sci 2014;35:285-307.
  20. Seo NG, Ahn SJ, Kang TW, Hwang YH. The study of estimating household catastrophic health expenditure using Korea Health Panel data. Korean J Health Econ Policy 2015;21(1):79-102.
  21. World Health Organization. Distribution of health payment and catastrophic expenditures methodology. Geneva: World Health Organization; 2005.
  22. Lee TJ, Yang BM, Kwon SM, Oh JW, Lee SH. Equity in the expenditures of health care services. Korean J Health Econ Policy 2003;9(2):25-34.
  23. Van Doorslaer E, Wagstaff A, van der Burg H, Christiansen T, De Graeve D, Duchesne I, et al. Equity in the delivery of health care in Europe and the US. J Health Econ 2000;19(5):553-583. https://doi.org/10.1016/S0167-6296(00)00050-3
  24. Wagstaff A, van Doorslaer E, van der Burg H, Calonge S, Christiansen T, Citoni G, et al. Equity in the finance of health care: some further international comparisons. J Health Econ 1999;18(3):263-290. https://doi.org/10.1016/S0167-6296(98)00044-7
  25. Song EC, Shin YJ. The effect of catastrophic health expenditure on the transition to and persistence of poverty in South Korea: analysis of the Korea Welfare Panel study data, 2007-2012. Health Policy Manag 2014;24(3):242-253. DOI: https://doi.org/10.4332/kjhpa.2014.24.3.242.
  26. Yang DW, Kim H, Kang E, Kim D, Bae EY, Kim J. Patterns and determinants of catastrophic health expenditure in the households with cancer patients. Korean J Health Econ Policy 2017;23(1):53-70.
  27. Jung HW, Lee JH. Effect of experience of catastrophic health expenditure on unmet medical need caused by economic reason. Korean J Health Econ Policy 2017;23(1):27-51.
  28. Waters HR, Anderson GF, Mays J. Measuring financial protection in health in the United States. Health Policy 2004;69(3):339-349. DOI: https://doi.org/10.1016/j.healthpol.2004.01.003.
  29. Ghislandi S, Crosignani PG, Negri E, La Vecchia C, Zocchetti C. Sex and age differences in health expenditure in northern Italy. Epidemiol Biostat Public Health 2014;11(4):10244. DOI: https://doi.org/10.2427/10244.
  30. Cylus J, Hartman M, Washington B, Andrews K, Catlin A. Pronounced gender and age differences are evident in personal health care spending per person. Health Aff (Millwood) 2011;30(1):153-160. DOI: https://doi.org/10.1377/hlthaff.2010.0216.
  31. Lim HK, Ahn YJ. Gyeonggido women health and policy agenda regarding life-cycle stage. Suwon: Gyeonggido Family & Women Research Institute; 2017.
  32. Jung YH, Byon L, Ko SJ. Lifetime distribution of medical cost in Korea. Health Soc Welf Rev 2001;31(1):194-216. DOI: https://doi.org/10.15709/hswr.2011.31.1.194.
  33. Lim JH. Analysis of unmet medical need status based on the Korean Health Panel. Health Soc Sci 2013;34:237-256.
  34. Park EJ. A study on the association between smoking and medical expenditure. In: National Health Insurance Service, Korea Institute for Health and Social Affairs, editors. Proceedings of the 3rd Conference of Korea Health Panel; 2011 Dec 1; Seoul, Kora. Wonju: National Health Insurance Service; 2011. pp. 177-190.
  35. Baek IR, Park HS, Byun SS. The determinants and medical care utilization behavior of private health insurance. J Korea Contents Soc 2012;12(7):295-305. https://doi.org/10.5392/JKCA.2012.12.07.295
  36. Choi SH, Cho YT. Sex differentials in the utilization of medical services by marital status. Korea J Popul Stud 2006;29(2):143-166.
  37. Park HC, Noh JW, Kim KB, Kwon YD. Ratio of household healthcare spending to household income. J Korea Contents Soc 2016;16(10):411-419. https://doi.org/10.5392/JKCA.2016.16.10.411
  38. Hwang GH. Analysis of gender wage gap among youth employees. Employ Issue 2017;23;22-38.
  39. Oh EJ, Kim SY. Career interruption of Korean female youth. Soc Sci Rev 2016;47(2):141-166.
  40. Jang HJ, Park HJ, Lee SM. Development of educational contents about gender-sensitive policy. Seoul: Seoul Foundation of Women & Family; 2013.
  41. Kim D, Tong J, Woo Y, Jeong J. Gender analysis on health promotion policies: focusing on youth and middled-aged population. Seoul: Korean Women's Development Institute; 2016.
  42. Kim NS. Women's health indicators: a glance through women's health STATS and FACTS in Korea. Health Welf Policy Forum 2016;235:6-14.
  43. Park JY, Jung KT, Kim YM. A panel study on determinants of catastrophic health expenditure of the middle- and old-aged households. Health Policy Manag 2014;24(1):56-70. DOI: https://doi.org/10.4332/kjhpa.2014.24.1.56.
  44. Jang SR. Relations between health, working and burden of health expenditure among baby-boomers. Labor Rev 2012;91:40-53.
  45. Korea Institute for Health and Affairs. Korean women's health statistics. Sejong: Korea Institute for Health and Affairs; 2003.
  46. Kim MG. Issue and policy task of the minimum cost of living. Health Soc Welf Issue Focus 2012;124:1-8.
  47. Kim YT, Jung JJ, Jeon HJ, Chun HR, Choi SS. A review on female health promotion in foreign countries and policy agenda in South Korea. Seoul: Korean Women's Development Institute; 2007.